William Shiel Jr., MD, FACP, FACR, Editor of MedicineNet's
Arthritis
Overview, Offers Perspectives Of Interest On Topics From 2005 Annual
Scientific Meeting of The American College of Rheumatology (held November 12-17,
2005)

Listen now to
installment #6 (transcript) on Rheumatoid Arthritis - From Dr. William Shiel who is at the
2005 Arthritis
Conference in San Diego, CA
(MP3 7:39min 3.5MB)

Rheumatoid Arthritis Treatment Update

This is Dr. William Shiel, chief medical editor for MedicineNet.com and
Rheumatologist reporting from the 2005 annual scientific meeting of the American
College of Rheumatology in San Diego - the national arthritis meeting.

I'm delighted to report that there are a huge amount and variety of research
papers presented at this meeting on rheumatoid arthritis. Rheumatoid arthritis
is the topic of this segment from the meeting

Rheumatoid Factor and Citrulline Antibody
Researchers reported that rheumatoid factor appears very early as does
citrulline antibody -- often times in patients who eventually develop rheumatoid
arthritis. In fact it seems to be much earlier in patients who develop
rheumatoid arthritis after the age of forty years. We know that both rheumatoid
factor positively and citrulline antibody -- also known as CCP antibody, is
associated with more aggressive disease in rheumatoid arthritis. Researchers
also reported that citrulline antibody is associated with the risk of eventual
development of rheumatoid arthritis and may present even up to 12 years prior to
development of rheumatoid arthritis. Now, it should be noted that this does not
mean that because you have citrulline antibody or rheumatoid factor present you
will definitely develop rheumatoid arthritis. It just means that doctors will
need to be monitoring your situation over time and should symptoms develop that
are consistent with rheumatoid disease, treatment may be warranted.

Rheumatoid Arthritis - Treated Seriously and Diligently
Researchers from Japan reported that tight control of rheumatoid arthritis with
aggressive treatment is necessary to prevent disability. Simultaneously,
researchers from the Netherlands also reported that immediate Disease-Modifying
Antirheumatic Drugs treatment (DMARDs) are necessary to prevent eventual
surgical treatment. What these two papers mean is that rheumatoid arthritis
needs to be treated seriously and diligently and preferably early in order to
prevent damaged to cartilage, bone, .deformity, and eventual disability. These
two papers significantly support previous studies.

Health Screenings
The higher risk of heart disease and stroke was emphasized in a number of
patients presented at this meeting. It is noted that because of this higher risk
patients should receive appropriate screening for cardiovascular disease such as
cholesterol measurement, obesity control, etc.

X-Ray Progression
Researchers from the Netherlands also reported that the injectable drug for
arthritis -- Humira also known as adalimumab inhibits x-ray progression in
rheumatoid arthritis despite numbers that appear to be in good control that
signify inflammation is at a minimum and disease is controlled by other clinical
measures. In other words, when the disease is still progressively active by
signs of inflammation the x-rays were not becoming worse or indicating more
damage to bone and joint. So apparently Humira seems to provide good control and
protection for the bone.

Researchers from Stanford, UCSD, Texas, and Britain reported analogously to
the previously mentioned study for the same clinical response in a patient with
rheumatoid arthritis -- those that were being treated with methotrexate had
worse x-ray progression then those who received methotrexate and Humira (adalimumab).
This difference in x-rays was noticed at six months and increased during the two
years of the study. This study also emphasizes that x-ray progression was better
controlled when an aggressive such as the treatment such as the injectable
Humira was added the methotrexate treatment. It was also noted by researchers in
Sweden, UCSD, University of Texas Southwestern that Humira taken every other
week with or without methotrexate is fine as a treatment for the vast majority
of patients and that weekly Humira did not significantly add benefit to most
patients and that weekly Humira does not significantly add benefit to most
patients. You see sometime doctors will advocate or recommend weekly Humira in
patients that aren't doing well. This study tells us that we should still start
out with every other week regimen.

Tumor Necrosis Factor (TNF) and Methotrexate
A paper was presented that showed that patients that received anti tumor
necrosis factor (TNF) treatment with methotrexate did better and had a more
sustained response to treatment then those that received TNF alone. It seems
that combination therapy is more effective in treating rheumatoid disease.
Moreover, researchers from the Netherlands reported that patients who failed
methotrexate alone adding another DMARD (disease modifying anti-rheumatic drug)
or switching to another DMARD was not significantly effective, but adding
Remicade (infliximab) was helpful. This seems to indicate that when we fail an
initial DMARD it is very reasonable to step up treatment to the aggressive
anti-rheumatic treatment that blocks TNF -- Enbrel (etanercept), Remicade (infliximab),
and Humira (adalimumab).

Abatacept - New Treatment for Rheumatoid Arthritis
Finally the last paper I would like to present was a paper from Stanford,
University of Cincinnati, Denver, and France in a multicenter study with a new
treatment that may be available soon. This treatment whose generic name is
abatacept, is used by intravenous infusion. This significant paper demonstrates
that abatacept works in patients who fail treatments that are directed against
tumor necrosis factor (TNF). This seems to be true in the research for any stage
of rheumatoid arthritis. By way of background, not all patients respond to TNF
drug treatment (Remicade, Emberal, and Humira). Abatacept which works by a very
different mechanism then these TNF drugs may soon be an option for patients
whose rheumatoid disease did not respond to TNF inhibiting drug.